Carpentier, P. A., Stanford, J. B., & Boyle, P. C. (2016). Progesterone in Women with Recurrent Miscarriages. The New England Journal of Medicine, 374(9), 894. https://doi.org/10.1056/NEJMc1600491
Carpentier PA, Stanford JB, Boyle PC. Progesterone in Women with Recurrent Miscarriages. N Engl J Med. 2016;374(9):894. doi:10.1056/NEJMc1600491
Carpentier, Paul A., et al. "Progesterone in Women with Recurrent Miscarriages." The New England Journal of Medicine, vol. 374, no. 9, 2016, pp. 894.
Pre-implantation progesterone merits study in recurrent miscarriage
In a 2016 letter to the editor, three physicians argue that progesterone started before implantation deserves study in women with recurrent miscarriage and reduced fertility. They respond to PROMISE, a randomized trial of women with three or more miscarriages. In that trial, progesterone began after implantation.
Study at a glance, letter to the editor of women with recurrent miscarriage: Letter asks for study of progesterone started before implantation. Source: Carpentier PA et al., 2016, PMID 26962922.
Key Findings
The letter suggests that correcting a luteal-phase defect ahead of implantation may raise the chance of an ongoing pregnancy.
Women in fertility treatment commonly receive progesterone before and during implantation, the letter notes, while PROMISE began it afterward.
Reduced fertility led to the exclusion of 515 of the 1568 women screened for PROMISE, nearly 33%.
Cited reports associate a luteal phase shorter than 10 days with a lower probability of clinical pregnancy, and the letter adds that it may also be associated with miscarriage.
In reply, the PROMISE authors say the trial tested first-trimester progesterone because it is common practice, and they agree the luteal-phase question merits further research.
Interpretation
The item is a 2016 letter to the editor in the New England Journal of Medicine, with a reply from the PROMISE authors. The letter concerns women with recurrent miscarriage and reduced fertility, who were excluded from the trial, and women with a short luteal phase. The PROMISE authors reply that progesterone use in the luteal phase is rare and that the question merits further research. The letter's authors call for investigation of progesterone before pregnancy testing in women with reduced fertility, a luteal-phase defect, or both.
RRM Context
Restorative reproductive medicine evaluates the menstrual cycle before pregnancy and treats the cause of a problem. Cycle charting shows how long the luteal phase lasts, so a short one can be found early. The letter applies this principle to recurrent miscarriage and directs attention to the time before implantation.
Our editorial summary of this paper, not the article's abstract.
